Some Cochrane risk of bias items are not important in osteoarthritis trials: A meta-epidemiological study based on Cochrane reviews

Julie Bolvig, Carsten B Juhl, Isabelle Boutron, Peter Tugwell, Elizabeth A T Ghogomu, Jordi Pardo Pardo, Tamara Rader, George A Wells, Alain Mayhew, Lara Maxwell, Hans Lund, Henning Bliddal, Robin Christensen, Editorial Board of the Cochrane Musculoskeletal Group

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Abstract

Objective: To evaluate the impact of bias-related study characteristics on treatment effects in osteoarthritis (OA) trials. Study Design and Setting: Based on OA trials included in Cochrane reviews, the impact of study characteristics on treatment effect estimates was evaluated. Characteristics included items of the risk of bias (RoB) tool, trial size, single vs. multisite, and source of funding. Effect sizes (ESs) were calculated as standardized mean differences (SMDs). Meta-regression was performed to identify “relevant study-level covariates” that decrease the between-study variance (τˆ 2). Results: Twenty reviews, including 126 OA trials with a high degree of heterogeneity, were included (τˆ 2 = 0.1247). Among the RoB domains, only patient blinding had an impact on the results (reducing heterogeneity according to τˆ 2 < 7%). Inadequate blinding of patients yielded larger effects (SMD Difference = 0.15; 95% confidence interval [CI]: 0.01-0.29, P = 0.035). The most important study characteristic was trial size (heterogeneity reduced by 25%), with small trials reporting larger effects (SMD Difference = 0.29; 95% CI: 0.16-0.42, P < 0.001). Conclusion: In musculoskeletal reviews addressing pain, all the items included in the Cochrane RoB tool might not be equally important. OA trial results may be affected by bias constructs that are not yet fully elucidated.

Original languageEnglish
JournalJournal of Clinical Epidemiology
Volume95
Pages (from-to)128-136
ISSN0895-4356
DOIs
Publication statusPublished - Mar 2018

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Epidemiologic Studies
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Keywords

  • Bias
  • Meta-analysis
  • Meta-epidemiology
  • Meta-research
  • Osteoarthritis
  • Pain

Cite this

Bolvig, J., Juhl, C. B., Boutron, I., Tugwell, P., Ghogomu, E. A. T., Pardo, J. P., ... Editorial Board of the Cochrane Musculoskeletal Group (2018). Some Cochrane risk of bias items are not important in osteoarthritis trials: A meta-epidemiological study based on Cochrane reviews. Journal of Clinical Epidemiology, 95, 128-136. https://doi.org/10.1016/j.jclinepi.2017.11.026
Bolvig, Julie ; Juhl, Carsten B ; Boutron, Isabelle ; Tugwell, Peter ; Ghogomu, Elizabeth A T ; Pardo, Jordi Pardo ; Rader, Tamara ; Wells, George A ; Mayhew, Alain ; Maxwell, Lara ; Lund, Hans ; Bliddal, Henning ; Christensen, Robin ; Editorial Board of the Cochrane Musculoskeletal Group. / Some Cochrane risk of bias items are not important in osteoarthritis trials : A meta-epidemiological study based on Cochrane reviews. In: Journal of Clinical Epidemiology. 2018 ; Vol. 95. pp. 128-136.
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title = "Some Cochrane risk of bias items are not important in osteoarthritis trials: A meta-epidemiological study based on Cochrane reviews",
abstract = "Objective: To evaluate the impact of bias-related study characteristics on treatment effects in osteoarthritis (OA) trials. Study Design and Setting: Based on OA trials included in Cochrane reviews, the impact of study characteristics on treatment effect estimates was evaluated. Characteristics included items of the risk of bias (RoB) tool, trial size, single vs. multisite, and source of funding. Effect sizes (ESs) were calculated as standardized mean differences (SMDs). Meta-regression was performed to identify “relevant study-level covariates” that decrease the between-study variance (τˆ 2). Results: Twenty reviews, including 126 OA trials with a high degree of heterogeneity, were included (τˆ 2 = 0.1247). Among the RoB domains, only patient blinding had an impact on the results (reducing heterogeneity according to τˆ 2 < 7{\%}). Inadequate blinding of patients yielded larger effects (SMD Difference = 0.15; 95{\%} confidence interval [CI]: 0.01-0.29, P = 0.035). The most important study characteristic was trial size (heterogeneity reduced by 25{\%}), with small trials reporting larger effects (SMD Difference = 0.29; 95{\%} CI: 0.16-0.42, P < 0.001). Conclusion: In musculoskeletal reviews addressing pain, all the items included in the Cochrane RoB tool might not be equally important. OA trial results may be affected by bias constructs that are not yet fully elucidated.",
keywords = "Bias, Meta-analysis, Meta-epidemiology, Meta-research, Osteoarthritis, Pain",
author = "Julie Bolvig and Juhl, {Carsten B} and Isabelle Boutron and Peter Tugwell and Ghogomu, {Elizabeth A T} and Pardo, {Jordi Pardo} and Tamara Rader and Wells, {George A} and Alain Mayhew and Lara Maxwell and Hans Lund and Henning Bliddal and Robin Christensen and {Editorial Board of the Cochrane Musculoskeletal Group}",
note = "Copyright {\circledC} 2017 Elsevier Inc. All rights reserved.",
year = "2018",
month = "3",
doi = "10.1016/j.jclinepi.2017.11.026",
language = "English",
volume = "95",
pages = "128--136",
journal = "Journal of Clinical Epidemiology",
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Bolvig, J, Juhl, CB, Boutron, I, Tugwell, P, Ghogomu, EAT, Pardo, JP, Rader, T, Wells, GA, Mayhew, A, Maxwell, L, Lund, H, Bliddal, H, Christensen, R & Editorial Board of the Cochrane Musculoskeletal Group 2018, 'Some Cochrane risk of bias items are not important in osteoarthritis trials: A meta-epidemiological study based on Cochrane reviews', Journal of Clinical Epidemiology, vol. 95, pp. 128-136. https://doi.org/10.1016/j.jclinepi.2017.11.026

Some Cochrane risk of bias items are not important in osteoarthritis trials : A meta-epidemiological study based on Cochrane reviews. / Bolvig, Julie; Juhl, Carsten B; Boutron, Isabelle; Tugwell, Peter; Ghogomu, Elizabeth A T; Pardo, Jordi Pardo; Rader, Tamara; Wells, George A; Mayhew, Alain; Maxwell, Lara; Lund, Hans; Bliddal, Henning; Christensen, Robin; Editorial Board of the Cochrane Musculoskeletal Group.

In: Journal of Clinical Epidemiology, Vol. 95, 03.2018, p. 128-136.

Research output: Contribution to journalReviewResearchpeer-review

TY - JOUR

T1 - Some Cochrane risk of bias items are not important in osteoarthritis trials

T2 - A meta-epidemiological study based on Cochrane reviews

AU - Bolvig, Julie

AU - Juhl, Carsten B

AU - Boutron, Isabelle

AU - Tugwell, Peter

AU - Ghogomu, Elizabeth A T

AU - Pardo, Jordi Pardo

AU - Rader, Tamara

AU - Wells, George A

AU - Mayhew, Alain

AU - Maxwell, Lara

AU - Lund, Hans

AU - Bliddal, Henning

AU - Christensen, Robin

AU - Editorial Board of the Cochrane Musculoskeletal Group

N1 - Copyright © 2017 Elsevier Inc. All rights reserved.

PY - 2018/3

Y1 - 2018/3

N2 - Objective: To evaluate the impact of bias-related study characteristics on treatment effects in osteoarthritis (OA) trials. Study Design and Setting: Based on OA trials included in Cochrane reviews, the impact of study characteristics on treatment effect estimates was evaluated. Characteristics included items of the risk of bias (RoB) tool, trial size, single vs. multisite, and source of funding. Effect sizes (ESs) were calculated as standardized mean differences (SMDs). Meta-regression was performed to identify “relevant study-level covariates” that decrease the between-study variance (τˆ 2). Results: Twenty reviews, including 126 OA trials with a high degree of heterogeneity, were included (τˆ 2 = 0.1247). Among the RoB domains, only patient blinding had an impact on the results (reducing heterogeneity according to τˆ 2 < 7%). Inadequate blinding of patients yielded larger effects (SMD Difference = 0.15; 95% confidence interval [CI]: 0.01-0.29, P = 0.035). The most important study characteristic was trial size (heterogeneity reduced by 25%), with small trials reporting larger effects (SMD Difference = 0.29; 95% CI: 0.16-0.42, P < 0.001). Conclusion: In musculoskeletal reviews addressing pain, all the items included in the Cochrane RoB tool might not be equally important. OA trial results may be affected by bias constructs that are not yet fully elucidated.

AB - Objective: To evaluate the impact of bias-related study characteristics on treatment effects in osteoarthritis (OA) trials. Study Design and Setting: Based on OA trials included in Cochrane reviews, the impact of study characteristics on treatment effect estimates was evaluated. Characteristics included items of the risk of bias (RoB) tool, trial size, single vs. multisite, and source of funding. Effect sizes (ESs) were calculated as standardized mean differences (SMDs). Meta-regression was performed to identify “relevant study-level covariates” that decrease the between-study variance (τˆ 2). Results: Twenty reviews, including 126 OA trials with a high degree of heterogeneity, were included (τˆ 2 = 0.1247). Among the RoB domains, only patient blinding had an impact on the results (reducing heterogeneity according to τˆ 2 < 7%). Inadequate blinding of patients yielded larger effects (SMD Difference = 0.15; 95% confidence interval [CI]: 0.01-0.29, P = 0.035). The most important study characteristic was trial size (heterogeneity reduced by 25%), with small trials reporting larger effects (SMD Difference = 0.29; 95% CI: 0.16-0.42, P < 0.001). Conclusion: In musculoskeletal reviews addressing pain, all the items included in the Cochrane RoB tool might not be equally important. OA trial results may be affected by bias constructs that are not yet fully elucidated.

KW - Bias

KW - Meta-analysis

KW - Meta-epidemiology

KW - Meta-research

KW - Osteoarthritis

KW - Pain

U2 - 10.1016/j.jclinepi.2017.11.026

DO - 10.1016/j.jclinepi.2017.11.026

M3 - Review

C2 - 29222059

VL - 95

SP - 128

EP - 136

JO - Journal of Clinical Epidemiology

JF - Journal of Clinical Epidemiology

SN - 0895-4356

ER -